Koroku, Miki & Omori, Teppei & Kambayashi, Harutaka & Murasugi, Shun & Kuriyama, Tomoko & Ikarashi, Yuichi & Yonezawa, Maria & Arimura, Ken & Karasawa, Kazunori & Hanafusa, Norio & Kawana, Masatoshi & Tokushige, Katsutoshi.

Intestinal Research. 2021 DOI:10.5217/ir.2020.00148.

Coronavirus disease 2019 (COVID-19), caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is now a pandemic. Although several treatment guidelines have been proposed for patients who have both inflammatory bowel disease and COVID-19, immunosuppressive therapy is essentially not recommended, and the treatment options are limited. Even in the COVID-19 pandemic, adjuvant adsorptive granulocyte and monocyte apheresis may safely bring ulcerative colitis (UC) into remission by removing activated myeloid cells without the use of immunosuppressive therapy. Our patient was a 25-year-old Japanese male with UC and COVID-19. This is the first case report of the induction of UC remission with granulocyte and monocyte apheresis treatment for active UC associated with COVID-19.

https://www.irjournal.org/journal/view.php?doi=10.5217/ir.2020.00148

https://www.irjournal.org/upload/pdf/ir-2020-00148.pdf

Makoto Naganuma, Yoko Yokoyama, Satoshi Motoya, Kenji Watanabe, Koji Sawada, Fumito Hirai, Takayuki Yamamoto, Hiroyuki Hanai, Teppei Omori, Takanori Kanai & Toshifumi Hibi, Journal of Gastroenterology volume 55, pages390–400 (2020)

Apheresis was well tolerated as maintenance therapy for UC although the cumulative clinical remission rate at 12 months was comparable between the apheresis and control groups.

Efficacy of apheresis as maintenance therapy for patients with ulcerative colitis in an open-label prospective multicenter https://link.springer.com/article/10.1007/s00535-019-01651-0#group-1

Hiroshi Nakase,^1,2Motoi Uchino,¹Shinichiro Shinzaki,¹Minoru Matsuura,¹Katsuyoshi Matsuoka,¹Taku Kobayashi,¹Masayuki Saruta,¹Fumihito Hirai,¹Keisuke Hata,¹Sakiko Hiraoka,¹Motohiro Esaki,¹Ken Sugimoto,¹Toshimitsu Fuji,¹Kenji Watanabe,¹Shiro Nakamura,¹Nagamu Inoue,¹Toshiyuki Itoh,¹Makoto Naganuma,¹Tadakazu Hisamatsu,¹Mamoru Watanabe,¹Hiroto Miwa,¹Nobuyuki Enomoto,¹Tooru Shimosegawa,¹ and Kazuhiko Koike¹ ,J Gastroenterol. 2021; 56(6): 489–526.

Inflammatory bowel disease (IBD) is a general term for chronic or remitting/relapsing inflammatory diseases of the intestinal tract and generally refers to ulcerative colitis (UC) and Crohn’s disease (CD). Since 1950, the number of patients with IBD in Japan has been increasing. The etiology of IBD remains unclear; however, recent research data indicate that the pathophysiology of IBD involves abnormalities in disease susceptibility genes, environmental factors and intestinal bacteria. The elucidation of the mechanism of IBD has facilitated therapeutic development. UC and CD display heterogeneity in inflammatory and symptomatic burden between patients and within individuals over time. Optimal management depends on the understanding and tailoring of evidence-based interventions by physicians. In 2020, seventeen IBD experts of the Japanese Society of Gastroenterology revised the previous guidelines for IBD management published in 2016. This English version was produced and modified based on the existing updated guidelines in Japanese. The Clinical Questions (CQs) of the previous guidelines were completely revised and categorized as follows: Background Questions (BQs), CQs, and Future Research Questions (FRQs). The guideline was composed of a total of 69 questions: 39 BQs, 15 CQs, and 15 FRQs. The overall quality of the evidence for each CQ was determined by assessing it with reference to the Grading of Recommendations Assessment, Development and Evaluation approach, and the strength of the recommendation was determined by the Delphi consensus process. Comprehensive up-to-date guidance for on-site physicians is provided regarding indications for proceeding with the diagnosis and treatment.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8137635/

Masanao Nakamura ¹, Takeshi Yamamura ¹, Keiko Maeda ², Tsunaki Sawada ², Yasuyuki Mizutani ¹, Eri Ishikawa ¹, Ayako Ohashi ¹, Go Kajikawa ¹, Kazuhiro Furukawa ¹, Eizaburo Ohno ¹, Takashi Honda ¹, Hiroki Kawashima ¹, Masatoshi Ishigami ¹, Mitsuhiro Fujishiro ¹

Intern Med. 2020 Dec 1;59(23):3009-3014. doi: 10.2169/internalmedicine.5302-20. Epub 2020 Jul 28.

Granulocyte and monocyte adsorptive apheresis (GMA) is occasionally introduced as an alternative combination therapy after loss of response to biologics in ulcerative colitis (UC) patients. However, there have been no reports of the concomitant use of vedolizumab (VDZ) and GMA for the initial induction of UC. A 20-year-old man with refractory UC was admitted for recrudescence. VDZ monotherapy had previously been introduced but was ineffective. Therefore, he received scheduled combination of VDZ and GMA and achieved clinical remission. The combination of two different approaches to inhibit the migration of leukocytes into the inflamed tissue led to satisfactory clinical outcomes.

https://pubmed.ncbi.nlm.nih.gov/32727993/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759717/

Shinji Okabayashi,¹Taku Kobayashi,¹ and Toshifumi Hibi¹ ,doi: 10.23922/jarc.2019-003

Ulcerative colitis and Crohn’s disease, the most common types of inflammatory bowel disease, are idiopathic, intractable disease characterized by chronic inflammation in the intestine. In recent years, studies elucidating the clinical characteristics of these diseases and basic researches have suggested that the diseases are induced by the immunological abnormalities through the involvement of environmental factors with their predisposition. In Japan, significant progress of basic and epidemiological researches has been developed for these diseases and the clinical guidelines have been established. However, no fundamental treatment for these diseases has been established yet. The current number of patients in Japan continues to increase, with at least 180,000 patients suffering from ulcerative colitis and 40,000 suffering from Crohn’s disease. Thus, further studies are required to understand these diseases and improve medical treatments

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6989123/

Kazuki Kakimoto ¹, Minoru Matsuura ², Takumi Fukuchi ³, Hitoshi Hongo ⁴, Tsuguhiro Kimura ⁴, Nobuo Aoyama ⁵, Yorihide Okuda ⁶, Kazuki Aomatsu ⁷, Noriko Kamata ⁸, Yoko Yokoyama ⁹, Chiemi Mizuno ¹⁰, Takuya Inoue ¹, Takako Miyazaki ¹, Shiro Nakamura ¹, Kazuhide Higuchi ¹, Hiroshi Nakase ¹¹ , Crohns Colitis 360. 2020 Sep 23;2(4):otaa073.

GMA shows effectiveness in inducing remission in UC patients not receiving steroid.

https://pubmed.ncbi.nlm.nih.gov/34192247/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7797742/pdf/otaa073.pdf

Yoichiro Shindo ¹, Keiichi Mitsuyama ², Hiroshi Yamasaki ^1 2 3, Tetsuro Imai ⁴, Shinichiro Yoshioka ^1 2, Kotaro Kuwaki ^1 2, Ryosuke Yamauchi ^1 2, Tetsuhiro Yoshimura ^1 2, Toshihiro Araki ^1 2, Masaru Morita ^1 2, Kozo Tsuruta ^1 2, Sayo Yamasaki ¹, Kei Fukami ⁵, Takuji Torimura, Ther Apher Dial 2020 Oct;24(5):503-510.

Single-needle (SN) apheresis may be safe and effective and may reduce patient burden during UC treatment. Nevertheless, further comparative studies are needed.

https://pubmed.ncbi.nlm.nih.gov/32526089/

Daniel Vasile Balaban, Mariana Jinga, Crohn’s Disease Recent Advances

While leukocyte-derived proinflammatory cytokines have been validated as successful targets in IBD treatment, so should leukocytes themselves be considered as treatment options. As activated leukocytes migrate into the bowel wall and drive the inflammatory cascade in IBD patients, their depletion by apheresis techniques are considered beneficial to control the mucosal inflammation.

Leukapheresis, consisting in either granulomonocyte apheresis or leukocyte apheresis, are cell-based therapies with promising results in some patient categories and with a good safety profile. They have been studied as an alternative in patients with steroid toxicity, dependency or refractoriness, or in the event of contraindications to conventional therapy. Most of the early studies were not controlled, with only a few randomized controlled trials providing quality data on their efficacy. Future studies should be designed to look at selection of IBD patients who benefit most and safely from this non-pharmacological therapy.

https://www.intechopen.com/chapters/73330

Daniel Vasile Balaban and Mariana Jinga Crohn’s Disease Recent Advances book, October 15th, 2020 DOI: 10.5772/intechopen.93605

Inflammatory bowel diseases (IBD) have become a major focus for gastroenterologists worldwide, with the increasing incidence and complexity of cases, which pose therapeutic challenges. Currently available approaches fail in controlling the disease activity in a significant proportion of patients and some of the therapies are associated with significant adverse events. Although new molecules are on the horizon and treatment strategies have been optimized, novel therapeutic tools are much needed in IBD for patients who fail to attain control of the disease. Apheresis is now a common non-pharmacological therapeutic modality used in several pathologies, IBD also. In the current review, we summarize currently available evidence with respect to selective apheresis in IBD.

https://www.intechopen.com/chapters/73330

Yoshiharu Yamaguchi ¹, Marie Nakagawa ¹, Shoko Nakagawa ¹, Kazuhiro Nagao ¹, Satoshi Inoue ¹, Tomoya Sugiyama ¹, Shinya Izawa ¹, Yasutaka Hijikata ¹, Masahide Ebi ¹, Yasushi Funaki ¹, Naotaka Ogasawara ¹, Makoto Sasaki ¹, Kunio Kasugai ¹ Intern Med  2021 Mar 1;60(5):725-730. doi: 10.2169/internalmedicine.5733-20. Epub 2020 Sep 30.

Aseptic abscesses (AAs) are extraintestinal manifestations of inflammatory bowel disease (IBD). IBD-associated AAs are rare in Japan. We treated a 45-year-old man with ulcerative colitis (UC)-associated AAs. During remission, multiple progressive abscesses were detected in the spleen; he underwent splenectomy because an infectious disease was suspected. Although his condition improved temporarily after splenectomy, a large liver abscess was noted, and a diagnosis of UC-associated AAs was made. Granulocytapheresis (GCAP) and infliximab (IFX) administration resolved the abscess. This is the first reported case of UC-associated AAs in a Japanese patient treated by splenectomy, GCAP, and IFX.

https://pubmed.ncbi.nlm.nih.gov/32999240/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7990631/